Preserving Urinary and Sexual Function After Rectal Cancer Surgery

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• Importance of Function Preservation
• Total Mesorectal Excision Technique
• Anatomy of Pelvic Nerves
• Consequences of Nerve Damage
• Modern Surgical Tools
• Choosing a Surgeon
• Full Transcript

Importance of Function Preservation

Preserving sexual function and urinary bladder function is a critical goal of modern rectal cancer surgery. Dr. Christoph Maurer, MD, emphasizes that patient quality of life is as important as achieving a cure. These functions were once accepted as inevitable casualties of treatment, but surgical advances now make their preservation a realistic expectation.

Total Mesorectal Excision Technique

The gold standard surgical therapy for rectal cancer is total mesorectal excision (TME). This technique is focused on complete tumor removal while prioritizing patient survival. Dr. Anton Titov, MD, notes that the procedure's success also hinges on maintaining a high quality of life post-operatively. The TME method is the foundation for preserving crucial pelvic nerves.

Anatomy of Pelvic Nerves

The key to preserving function lies in understanding pelvic nerve anatomy. Dr. Christoph Maurer, MD, explains that the autonomic pelvic nerves run very close to the mesorectal fascia. Surgeons refer to this dissection plane as the "holy plane" in rectal cancer surgery. Staying within this precise plane allows surgeons to protect the nerves responsible for urinary control and sexual function.

Consequences of Nerve Damage

Historically, nerve damage during surgery led to severe side effects. Dr. Christoph Maurer, MD, states that before modern techniques, almost every male patient was left completely impotent. Women also experienced a total loss of libido. Urinary bladder function was severely compromised, with patients unable to empty their bladder due to denervation. These problems are now largely avoidable with correct surgical methodology.

Modern Surgical Tools

Advanced instrumentation supports precise surgical dissection. Dr. Christoph Maurer, MD, highlights the use of precise cautery and even water-jet dissection. These modern tools help surgeons remain within the correct anatomical plane with greater accuracy. This technological progress, combined with superior surgical education, creates a better overall experience and outcome for rectal cancer patients.

Choosing a Surgeon

Selecting a highly skilled colorectal surgeon is paramount for a successful outcome. Dr. Anton Titov, MD, underscores that the surgeon must have expert knowledge of the anatomy around the rectum and the latest techniques. Seeking a second opinion for rectal cancer can help patients find a surgeon proficient in nerve-sparing procedures, ensuring the best chance to preserve function without sacrificing the cancer cure.

Full Transcript

Preserving sexual function after rectal cancer surgery is very important. Urinary bladder function preservation is also important in rectal cancer treatment. Rectal cancer operation aims to preserve sexual and urinary bladder function.

Rectal cancer treatment for men can have possible sexual side effects from surgery. It is important to choose the best surgeon who can minimize pelvic nerve damage during the operation.

Dr. Anton Titov, MD: For rectal cancer surgical treatment, total mesorectal excision technique has become the gold standard of surgical therapy for rectal cancer. Rectal cancer surgery and overall treatment are focused on the patient's survival and cure. But quality of life after rectal surgery is also very important.

Male sexual health after rectal cancer surgical treatment can be good. Urinary incontinence is an often unrecognized rectal cancer treatment risk. It can be reduced by the correct surgical method to remove the rectal cancer tumor.

Colorectal cancer and urinary incontinence are not inevitable consequences of rectal cancer surgical treatment if surgery is done correctly. Rectal cancer second opinion helps to find the best treatment options. Problems with urinary function and sexual function used to be accepted as normal previously.

But you studied extensively surgical techniques that preserve urinary function and sexual function so that most rectal cancer patients can retain sexual and urinary function after rectal cancer surgery. What is the progress in preservation of urinary function and sexual function after rectal cancer surgery?

What are the best options for patients to keep urinary and sexual function after surgery for rectal cancer, and do so without loss of curative potential for rectal cancer treatment?

Dr. Christoph Maurer, MD: Yes, indeed. Surgeons have learned to preserve the autonomic pelvic nerves. Autonomic pelvic nerves are very close to the mesorectal fascia. This dissection plane is the holy plane in rectal cancer tumor surgery.

We have learned to identify this tiny mesorectal fascia. Then we are able to preserve the pelvic nerves. They are just in the neighborhood of the mesorectum.

If we stay close to the mesorectal fascia during rectal cancer surgery, we can preserve the pelvic autonomous nerves. This preserves sexual and urinary function. And this is crucial for the patients.

Before adopting this technique, almost every male patient was completely impotent after surgery. Also, women were impotent with no libido. And the bladder function was sometimes really bad.

People could not empty their urinary bladder because their bladder was denervated. So this problem of bladder denervation today has completely gone because we can preserve the nerves. Because we know the exact surgical anatomy.

This is the best rectal cancer surgical treatment method.

Dr. Anton Titov, MD: So it's very important that the colorectal surgeon knows the exact anatomy around the rectum. The surgeon must know the latest surgical techniques so that the surgeon can make sure that the autonomic nerves are preserved during the surgery.

Dr. Christoph Maurer, MD: Exactly, exactly. Nowadays we also have the tools. We have precise cautery. Some surgeons even use water-jet dissection so they can stay within the correct anatomical plane.

So we have better instruments and better tools.

Dr. Anton Titov, MD: So better tools and more modern tools help with better surgical education. Together they create a better experience for patients with rectal cancer after surgery.

Dr. Christoph Maurer, MD: Correct.